Terms Definitions
intracellular fluid
hypochloremia or hyperchloremia
Renin-angiotensin-aldosterone system system initiated by specialized receptors in the juxtaglomerular cells of the kidney nephrons that respond to changes in renal perfusion
Reflexes reduced
EKG-inverted T-waves and depressed ST Segment
Assess for muscle cramping
Decreased HR and BP
Sounds of bowl decreased, constipation, vomiting
anions are
negatively charged electrolytes
Mnemonic for hypocalcemia SS?
Hyperkalemia- causes
Renal insufficiencyCellular destructionExcessive administration of KaAdrenal Insufficiency- too little aldosterone.
skeletal muscle weakness, muscle twitching, paralysis, decreased bp, ekg changes, possible cardiac arrest, n/v, diarrhea, metabolic alkalosis, mental confusion and depression
PLASMA: fluid within blood vessels
hypomagnesmia caused by
malnutrition, alcholism, diarrhea
Fluid Assessment
Systems approach
Mental Status
Fluid volume changes result in changes in mental status
Quality and rate of pulses
Peripheral vein filling
Neck veins/JVD
Peripheral edema
Transcellular fluid compartment of extracellular fluids, which include cerebrospinal, pericardial, pancreatic, pleural, intraocular, biliary, peritoneal, and synovial fluids
higher pressure to lower pressure
*partial pressure of CO2
*reflects adequacy of alveolar ventilation, regulated by lungs, alterations indicate resp disturbance
*normal values 35-45 mmHg (less is alkalotic, more is acidotic)
Primarily NaCl or HCL, Acid-base balance, Vascular volume
Re-absorption via the kidneys
positively charged ion; normal level is 4.5 mEq/L; 99% is in bones and teeth; deposited in the bones and mobilized as needed to help keep the blood level constant during any period of ins intake; vitamin D, calcitonin, and parathyroid hormone are necessary for absorption and utilization of calcium; the best food sources are milk and cheese
What is the electrolyte imbalance referring to high sodium?
Fluid Gain (in disease)
heart/liver/kidney failure
(cause fluid gain or loss?)
Commonly pair with: inversely follows calcium (means low P- is equal to high Ca+)
Maintain normal muscle and nerve function
Keeps heart rhythm steady
Supports a healthy immune system
Role in carbohydrate and protein metabolism
Hyperkalemia occurs _____ than hypokalemia, but is more __________
less; lethal
Hyponatremia deficiency of sodium in the blood plasma
the kidney's retain sodium when arterial pressure is
respiratory alkalosis causes (4)
hyperventilation, sepsis/infection, over ventilation, hepatic cirrhosis
Metabolic acidosis manifestations
(low pH <7.35)
( bicarbonate <22 mEq/L)
headache, confusion, drowsiness, increased respiratory rate and depth, decreased blood pressure, decreased cardiac output, dysrhythmias, shock, if decrease is slow patient may be asymptomatic until bicarbonate is 15mEq/L or less
treatment of hypokalemia
hypertonic glucose solution, monitor, i&0, bowel sounds, vs,cardiac rhythm, myscle strength, digoxin level if neccessary
Hypophosphatemia management
MEDICAL: oral or IV phosphorus replacement
NURSING: encourage foods high in phosphorus, and gradually introduce calories for malnourished patients receiving parenteral nutrition
Fluids include: > 0.9% NS (3%NS, 5%NS)/D10W/D50W
is due to vomiting, diarrhea, laxative abuse, severe sweating or medications. Manifests as hyperactive reflexes, muscle weakness & cardiac disturbances. Tx. restore normal K balance with foods, meds & IV fluids
1. Serum Na+ greater than 145mEq/L SODIUM EXCESS
2. Causes- excess water loss, excess sodium admin, diabetes insipidus, heat stroke, hypertonic iv solutions
3. Manifestations- thirst, elevated temp, dry swollen tongue, sticky mucosa, restlessless, neuro sympt.
Lactated Ringers
isotonic solution similar to plasma that has less NaCl, but more K, Ca, & PO4. (used to expand CHF)
<1.5 mEq/L Occurs more than hyper.. chronic alcoholism is most common cause
causes of hypovelemia
-internal / external bleeding
-fluid loss
-inadequate fluid intake
Primary sx: dehydration ; Other sx: Fluid overload, cerebral edema, Neuro sx = disorientation, seizures, coma, and death
Acid-Base Imbalances
1. respiratory ACIDOSIS 2. Respiratory ALKALOSIS 3. Metabolic ACIDOSIS 4. Metabolic ALKALOSIS
RBC, albumin (solids of blood); need facillitated diffusion
Potassium (K+)
Maintained by sodium-potassium pump in cells
K+ changes  altered excitability of muscles, neurons, pancreatic cells (release insulin)
Eliminated by kidneys (renal problems)
Cause K+ to move from ECF  ICF: Insulin
Cause K+ to move from ICF  ECF: acidosis, trauma to cells and exercise
this electrolyte is found in the ICF and effects heart and neuromuscluar activity. Also does biochemical stuff.
where do you see saline?
ECF - extracellular fluid
Hyperphosphatemia causes
(serum level above 4.5 mg/dL)
renal failure, excess phosphorus, excess vitamin D, acidosis, hypoparathyroidism, and chemotherapy
Blood products are also known as...
oxygen-carrying resuscitation fluids
the most abundant electrolytes in sweat are ____ and ____
sodium and chloride
Electrolyte imbalance
When cells die, the cell contents empty into the ECF causing what?
Fluid Volume Deficit
Defining Characteristics of ______ is VS, dry mucus membranes, Skin turgor > 3 secs, Decreased urinary output, Recent weight loss, Hand vein filling > 3 secs. Decreased pulse and threadyDecreased B/P, best to check skin turgor over sternum and forehead. sunken eyeballs
syncope, postural hypotension, increased thirst
Lab most elevated due to decreased volume of plasma
interstitial fluid
fluid between the cells and outside the blood vessels
Chvosteks's sign
tapping 2 inches anterior of someone's ear and assessing for twitching
linloeic acid
the only essential fatty acid in humans
Repiratory alkalosis
pH>7.45, PaCO2<35 mm Hg, PaO2 normal and bicarbonate normal.
Signs and Symptoms dizziness, confusion,dysrythmias, tachypnea, numbness and tingling of extremities, convulsions and coma. 
metabolic acidosis: labs
low bicarb, decreased BE, increased anion gap, hyperkalemia (from breakdown of cells from acidosis), high metabolic acids (lactic acids, ketoacids)
calcium and phosphorous
these 2 electrolytes have an inverse relationship.
Name the etiologies for hypokalemia
increased cellular uptake, decreased intake, increased loss of total body potassium
______ IV fluids are used mainly to prevent dehydration.
5% dextrose
osmotic pressure
pressure exerted by the protein in the plasma, albumin is a water magnet
Partial Parental Nutrition-PPN
10% glucose
can be given in a peripheral IV
TPN and PPN are Hypertonic solutions
high phosphorus
>4.5 mg/dl occurs when this shifts out of the cells into ECF (due to tissue trauma or chemo for tumor) In renal failure, or when excess has been given
an isotonic gain of water and Na to ECF which exceeds output
Repiratory acidosis
Normal pH 7.35-7.45
PaCO2 partial pressure of carbon dioxide 35-45mmHg
An increased arterial carbon dioxide concentration(PaCO2), exces carbonic acid(H2CO3), and an increase Hydrogen ion (H+) concentration (decreased pH). Signs and symptoms confusion,dizziness,lethargy, headache, ventricular dysrythmias, warm and flushed skin, muscular twitching, convulsions and coma.
partial compensation
buffers are in the process of working; pH is low but the bicarb is elevating to compensate (or pH is high but CO2 is elevating to compensate)
Causes of Hyponatremia
(less than 135 mEq/L)
adrenal insufficiency, water intoxication, SIADH, and losses by vomiting, diarrhea, sweating, and diuretics
Trousseau's sign is
a carpal spasm induced by inflating a blood pressure cuff above the systolic pressure for a few minutes.
Fluid Compartments
ECF; ICF (all fluid within cells - 70% of body fluids)
HCO3 bicarb
22-26 mEq/L present in both ICF & ECF primary function is to regulate acid base balance EC levels are regulated by the kidneys, excreted when too much is present, if more is needed the kidneys both regenerate and reabsorb, major buffer in the ECF and ICF
Phosphate HPO4 - -
part of ATP, buffer in acid-base balance (1.7-2.6)
Identify conditions that can cause hyponatrmeia through water gain
chronic renal insuffieicney, hypothroidism, SIADH, excessive thirst, heart failure, hepatic cirrhosis, nephrotic syndrome
What are the substances that are actively transported through the cell membrane?
Sodium, Potassium, Calcium, Iron, Hydrogen, Amino Acids, and Glucose
pushing a fat man into a crowded subway car
example of active transport
intake, absorption, distribution, excretion
what are the 4 processes that result in homeostasis
Troponin I
peak 14-20 hours. Normal within 5 - 7 days.
NA (nerve muscle depolarization) and Cl
are the two chief extracellular ions found outside cells
Causes of Abnormally low values of HCO3-
Diarrhea, Diuretics, Renal insuffi-ciency, ↑ Cl- administration, DKA, Lactic acidosis, uremia, ASA poisoning
5 other examples of foods that are good sources of K
yogurt, tomato juice, bananas, lima beans, clams
What are the routes of loss for a person?
kidney (urine output), skin loss (sensible and insensible losses, lungs, GI tract, other)
Causes of Abnormally high values of HCO3-
Loss of H+ ions (loss of gastric fluids via vomiting/suction, ↑ aldosterone level, ↑ HCO3- intake via antacids or IV NaHCO3
local and systemic
# of osmoles/kg
Hypocalcemia- causes
HypoparathyroidPancreatitisLow dietary CaAlkalosisRenal disease (kidneys activate V-D, Vit D helps absorb Ca)
Ca range:
Serum: 8.6-10.2
Ionized: 4.5-5.1
Main fluid compartment
Intracellular fluid
solutions that contains electrolytes
Hypocalcemia: signs and symptoms
Hypermagnesemia management
avoid administering medications containing magnesiun, provide patient teaching regarding magnesium-containing OTC meds
Bicarbonate (HCO3)
body's primary buffer system
Osmotic pressure b/w extracellular fluid and intracellular fluid. outside = osmolarity. inside the body = osmlality. basically means osmotic pressure.
When is hypercalcemia present?
acidosis, hypophosphatemia
Conditions Excess intake, Trauma, Acidosis, Renal Failure. Symptoms: Cardiac dysrhythmias, anxiety, irritability, flaccid paralysis, abdominal cramping, diarrhea
Water Excess- Treatment
DiureticsLimit fluid intakeDialysis
Hyperphosphatemia management
MEDICAL: treat underlying disorder, use vitamin D preparations, calcium-binding antacids, phosphate-binding gels or antacids, loop diuretics, NS IV, and dialysis
NURSING: assessment, avoid high phosphorus foods, provide patient teaching related to diet, phosphate containing substances, and signs of hypocalcemia
solution exerting equal pressures on opposite sides of the membranes, used to expand the ECF compartment
Hyperkalemia management
MEDICAL:monitor ECG, cation exchange resin (Kayexalate), IV sodium bicarbonate, IV calcium gluconate, regular insulin and hypertonic dextrose IV, and B-2 agonists: limit dietary K and perform dialysis
NURSING: assess serum K levels, mix well IVs containing K, monitor meds effects, initiate dietary K restriction and dietary teaching for patients at risk
Treatment of Hypercalcemia
-assess VS
-decrease intake
-maintain hydration
-monitor for renal calculi
kidneys filter
180L/day and excreate ~1500 mL/day
chemical compunds that remain intact; ie: urea & glucose.
`Bicarbonate (HCO-3)
HCO-3 is base (alkalidic)
causes of hypervolemic hyponatremia
-heart failure
-liver failure
-hypotonic IV
common hypotonic fluids
1/2 NS(0.45% Sodium chloride)
The major electolyte found in ECF
Hypernatremia- Clinical manifestations
Mental status decreaseDecreased turgorDry Skin and mucous membranesThirst
decreased serum K
EKG with inverted T-wave, and depressed ST segment
ABGs metabolic alkalosis
extracellular fluid compartments
interstitial fluid and intravascular fluid
Hyponatremia is when sodium is less than _____mEq/L.
____ are chemicals that dissolve in water and dissociate into their positive or negative ions
Sensitive to osmolality
respond to osmolality (concentration in ECF - vascular); osmolality refers to fluid in body; decreased plasma in fluid - increased solute concentration; Cells dehydrate as fluid shifts into vascular - thirst
hypermagnesemia symptom
feeling of warmth (inside to out)
6 L's (lesbians) (hypokalemia ss)
Leg cramps
Limp muscles
Lethal Arrhythmias
Low, shallow respirations
Lots of urine
Active transport
movement of substances across cell membranes against the concentration gradient
solution in which a solute is dissolved; in the body water is the solvent and the solutes are electrolytes, oxygen, carbon dioxide, glucose, and proteins
caused by result of breathing more rapidly, which increases the amount of CO2 exhaled
Calcium- function
formation of bone and teethblood clottingmyocardial contractilitynerve impulse conduction (suppressant effect)
Ca++ Significance
Important to muscle and vascular contraction; clotting; CNS fx and nerve transmission; Stored primarily in bones
Hypovolemic shock
an emergency condition in which severe blood and fluid loss makes the heart unable to pump enough blood to the body. This type of shock can cause many organs to stop working. The body tries to adapt by increasing the HR and peripheral vasoconstriction to increase the volume of blood returned to the heart and increase cardiac output
intracellular fluid
largest of the two compartments and contains the fluid inside the billions of cells within the body
Manafestations of Hypernatremia
thirst, elevated temp, dry, swollen tongue, sticky mucosa, neurologic sysmptoms, restlessness, weakness
medical management of Hypernatremia
Hypotonic electrolyte solution or D5W
(D5W contains no sodium)
Severe muscle cramps/spasms Chvostek and Trousseau signs (hypocalcemia)
Ca deficit, Mg deficit
hypovolemic hyponatremia ssessment findings
-rapid thready pulse
-low BP
-cold clammy skin
hypotonic fluids IV
push fluid out of intravascular compartment into interstitial and intracellular spaces.
Spacing (1st 2nd 3rd)
1st=normal 2nd=fluid in interstitial spaces, edema 3rd=fluid accumulation where there is normally none. (fluid can communicate in 2nd spacing, but is lost in 3rd spacing) (ascites)
Magnesium needed for what
cellular transport of Na, Kneuromuscular tonecellular metabolism (ATP)
Abnormally high values of Cl-
Hyperchloridemia > 106 mEq/L
(Ca+) hypo symptoms
numbness and tingling of fingers and circumoral region,
+ Trousseau's sign,
+ Chvostek's sign
Metabolic alkalosis manifestations
(produced by hypokalcemia)
symptoms related to decreased calcium, respiratory depression, tachycardia, and symptoms of hypokalemia
____ is when the hypothalamus stimulates the release of ADH from the posterior pituitary then ADH ____ the absorption os water by the kidney tubules which makes blood volume _____ and urine output ____
dehydration increases increase decreases
Interstitial and Intravascular
What are the two types of EXTRAcellular fluid?
Respiratory alkalosis
A deficity of carbonic acid or a decrease in hydrogen ion concentration that results from teh acculuation of base or from a loss of acid without a comparable loss of base in the body fluids. This occurs in conditions that cuase overstiumlation of the respiratory system.
What do you check for hypocalcemia?
chvostek's and trousseau's signs
Insensible Water Loss
continuous and occurs through the skin and lungs, not perceived by the person, can be considerable with burns or fevers
hypocalcemia definition, s/s, tx
low calcium caused by decreased intake, increased phosphate, renal disease, acute pancreatitis, hypoparathyroidisms/s: deep tendon reflexes, neuro changes, paresthesia, arrhythmiatx: calcium supplement PO / IV
Signs and symptoms of hyponatremia
hyponatremia: brain swells, symptoms include headache, lethargy, confusion, obtundation, seizures, coma
Name the clinical manifestations of hyperphosphatemia
increased RBC count, hypocalcemia, tetany
What maintains the levels of K+?
the adrenal gland hormone, aldosterone
fluid and electrolyte balance is maintained by
intricate & complicated homeostatic mechanisms
isovalemic hyponatremia
-too much fluid in the body, sodium is diluted
isotonic fluid volume excess
abnormal retention of both sodium and wateredema
What are Potassium Side Effects & Adverse Effects?
GI: diarrhea, nausea, vomiting, bleeding, ulceration
Phlebitis (from IV administration)
Hyperkalemia: muscle weakness, cardiac dysrhythmias (ventricular dysrhythmias & cardiac arrest), paresthesia, paralysis
_____ is secreted by the atria when blood volume or blood pressure increases. Then ______ the reabsorption of sodium ions by the kidneys this ______ urinary output of sodium and water.
ANH(atrial natriuretic hormone) decreases increases
Eating lots of antacids can do what to mg?
Increase its levels
Nutritional Considerations(Foods with high content) of Cl-
Table salt (NaCl) and salt substitutes (KCl); Rye, Tomatoes, Milk, Lettuce, Celery, Olives
How to correct metabolic alkalosis underlying disorder
supply chloride to allow excretion of excess bicarbonate, and restore fluid volume with sodium chloride solutions
what is the most dangerous electrolyte imbalance
- it can stop the heart
What can K-sparing diuretics cause
an elevation of K and should not be used in patients with renal dysfunction
the lower teh PaO2 pressure, the ....
less oxygen available to bind with Hb
What are the main differences between hypo and hyper natremias?
One involves FVE and other FVD; one increases blood thickness, one decreases it; one increases cell excitability and the other decreases
What is SIADH and what is its effect on fluid balance and sodium levels?
excessive release of ADH results in hyponatremia and fluid volume excess
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